X-ray treatment structure



Oct. 25, 1938. A. F. JEANS X-RAY TREATMENT STRUCTURE Filed A ril 24}1957 4 Sheets-Sheet 1 T .W mm Jfl v FX 1:: i: F2 m H Mn y M H 00m m Oct.25, 1938. A. JEANS 2,134,191

X-RAY TREATMENT STRUCTURE Filed April 24, 19-37 I 4 Sheets-Sheet 2 Room1.

/// 2 4/, I my?) 26 4 Room 4 [2 A V A I0 I II Il' I" W" UTTUQI'JOZIT IATI11UI F Jeans A. F. JEANS X-RAY TREATMENT STRUCTURE Oct. 25, 1938.

4 Sheets-Sheet 5 Filed April 24, 1937 Row. 2

Patented Oct. 25, 1938 1 '2 134J91 UNITED STATES PATENT OFFICE 2,134,191X-RAY TREATMENT STRUCTURE Arthur F. Jeans, Toronto, Ontario, CanadaApplication April 24, 1937, Serial No. 138,720 7 Claims. (01. 250-34)The invention relates to improvements in X- to assume or lie in thevarious positionsdemanded ray therapy for cancer treatment as describedby existing tables. A supervoltage tube'o'f the in the presentspecification and shown in the type referred to for the purpose ofperforming accompanying drawings that form part of the the presentinvention is disclosed in the publisame. cation Radiology vol. .27, No.2, pages 208-216, 5

The invention comprehends the novel con- August, 1936. The Jdifiicultyin utilizing this struction and arrangement of a group of treattubearises in the treatment rooms, and the main ment rooms and an imperviousdrum common problems encountered are enumerated as follows: thereto inwhich windows are 50 disposed as to 1. Immobilization of the patients,many of 10 emit X-ray beams at such angles that several whom arerequired to lie absolutely still" for an 10 patients may be treatedsimultaneously and prihour at a time, for which purpose a suitablevately. A distinctive feature of the invention treatment table must beemployed. In'practice, resides in so constructing the rooms relative tothe table is about 6.5 feet long, and since any the drum that eachpatient is disposed within part of the bodyniay require treating andfrom' 15. the effective distance from the X-ray source. any angle, thefour extreme positions determine A further salient feature lies in theprovision. the necessary range of movement ofthe table. of revolvabletables, each having a vertical axis The four extreme positions are thosewhich acabout which a patient is adjustable in order to commodatetreatment of the head of the patient. bring the part of the person tobe, treated in It may be treated from either side, from the top,

alignment with the axis of rotation and at an or from beneath, i. e.,under the chin. To em-' 20 angle to the X-ray beam. This enables thepabraces'uch plural positions, 'a "circular range of tient to berevolved or oscillated in an arc of a about ten feet is essentia. circlerelative to the fixed beam so as to treat the t 2. The maintaining ofthe proper skin target diseased part from different directions. distance(S. T. D.) is an all-important factor 5 By those familiar with the art,it is recognized controlling the dose when the tube is working at thatthe treatment of patients suffering, from full output. The skin targetdistance lsthe acdeep-seated malignant growths, by means of tualdistance from the source of radiation (the deep- X-ray therapy israpidly entering a. new anode or anticathode) to the surface of thepafield. X-rays produced by potentials of about tient. As this, distanceis decreased the intensity 200 kv. are now superseded by those producedby of the radiation increases andv vice versa. Ac- 30 potentials from400 to as high as 1,200 kv. The cording to modern equipment, a skintarget distubes designed for this purpose are capable of tance of notmore than 1 metre is necessary. emitting effective radiation from two tofive win- The intensity of the X-ray beam is similar to dows, which fromthe standpoint of economy that of light radiation in that it decreaseswith ofisets the increased expenditure involved in such Increasingdistance from the source according to 35 installations and theadditional cost of operating the square root law. Intensity iscontrolled at the supervoltage therapy apparatus. The nature the tube bytwo-main factors,athe voltage and of these tubes, however, invests themwith the current through the tube; both of which arelimdisadvantages ofimmobility. The present inited .by various technical problems. Hence thevention overcomes this disadvantage by providintensity of the tube islimited, and notthe least 40 ing for positional movement and adjustmentof of these problems is the cooling of the anode. the patient relativeto the tube. The intensity is measured in roentgens and. mod- Whilesatisfactory generating equipment is ern practice demands an intensityof '10 to 20 available for such supervoltage machines and roentgens per,minute.

while relatively satisfactory X-ray tubes, measur- Inasmuch as the skintarget distance must be 45 ing devices and controls can be installedwith maintained, the problem of arranging four palittle trouble, asuitable and practical method of tients around the tube so that thetables .01 beds pplying the treatment has hitherto not been may lie onemetre distance from the tube developed. The majority of methodssuggested anode or target and at the same time allow free by Xraymanufacturers are necessarily limited play of about 10 feet for the 6.5foot tables, is one 50 in their scope by reason of the fact that theyare that must be overcome before the maximum only applicable toconditions in which the paadvantages of the tube may be had. A simpletients are capable of movement of their own p titio i g o e treatmentrooms will not volition. This does not, however, take care of bringabout this'result, as. a study of the prob-- he l r e p rcentage ofpatients who are unable lem will show. so far asI am aware, the design-55 ers of four portal tubes have not been able to offer a satisfactorysolution to the problem that is overcome by the present invention.

A further consideration, that of scatter radiation, makes it necessaryto partition the space around the tube into separate compartments foreach patient and to so construct the partitioning walls as to embody anX-ray absorbent substance in order that radiation thrown back from thebody of one patient willnot radiate deleteriously to another patientconcurrently undergoing treatment.

This invention presents a structure and method of treatment by which theimmobility of super voltage machines is not only overcome, but augmentedby flexibility and accuracy exceeding that of existing shock proofapparatus.

A most vital feature of the present invention resides in the arrangementof the treatment rooms combined with the angle at-which the X-ray beamis introduced into each of them, as illustrated in the drawings. Fourrooms are shown, and according to the arrangement by which one patientcan lie partially below another in a different room, complete freedom ofmovement is obtainable and strict privacy is assured.

' Referring to the accompanying drawings, Figure 1 is a verticalsectional view of the group of rooms and showing patients undergoingtreatment.-

:Figures 2 through -5 are respective perspective views'of rooms I to 4inclusive.

Figure 6 is a slightly modified form of the in-v Vention in which therooms are grouped with respect to a vertical drum.

Figure 7 is a vertical sectional view through the drum showing the X-raytube. 5

Referring particularlytoFigures 1 to 5 inclusive, the reference numerall denotes a horizontally arranged drum impervious to' X-rays from theinteriorly mounted X-ray tube II. This drumis immovablymounted and formsa part of the'building.

The horizontal wall l2 forms the floor of room I and merges into a' sideof thedrum below the centre: thereof. The drum has a window l3 radiallydisposed to direct an X-r'ay beam l4 into this room at a slight upwardangle.

v The treatment chamber is provided with a platform or bench" lsupporting the table [6. The platform extends outwardly from the drum'atright angles to its length, and the table is of the tilting typeprovidedwith aconventional universal movement whereby it may be shiftedlongitudinally and transversely. Additionally, in order to carry out thepresent invention, a special rotatable mounting I1 is incorporated inthe table by which it is revolvable about the vertical axis 18. Thepatient is adjustedso that the skin target is in alignment, orsubstantially so, with saidvertical axis. The irradiation thusintercepts the vertical axis at an angle. A'power or manual operatingmeans may be employed to turn the table on its rotatable mounting. Themotion may be circular or oscillatory about the axis of rotation.

l The horizontal wall l9exten'ds from thedrum H! on the opposite sidethereof to that of the wall [2 and at a higher elevation, as shown. Thewall I9 constitutes the floor of the room 2 for separately treatinganother patient, illustrated as recumbent upon the table 20 supported onthe platform or bench 2|. 'This table is similar in construction to thataforementioned, and its vertical axis of rotation is denoted at 22 andis intercepted by the beam of irradiation rays 24 emanating from thewindow 25. This window is positioned normal tothe window l3 so as todirect its beam at an angle to a vertical line projected upwardly fromthe drum.

A partitioning wall 26 forms a continuation of the floor wall l9 andextends from the top of the drum at an upward angle over the wall l2 toa point at which it is joined to the vertical partitioning wall 21. Bythis construction it will be evident that sufficient space is availableto provide for the required movement of the tables and the patients inboth rooms with respect to focus point within the drum.

The horizontal wall 28 forms the floor of the room 3 and is situatedbeneath the wall l9 but on a slightly higher elevation than the floor 29of room' l. The wall 28 terminates short of the drum and has a verticalpartitioning wall 30 joined to the horizontal wall 3| subjacent to thedrum and joined thereto by the wall 32.

The room 3 is equipped with a platform or bench 33 supporting the table34 rotatable about the vertical fixed axis 35 intercepted by the beam 36downwardly and outwardly directed from the .window 31 diametricallyopposite the window l3.

Accordingly, the table 34, together with the patient, may be freelymanipulated in juxtaposition tothe beam source while maintaining'therequired distance for the skin target. 7

The walls 30 and 3| form an alcove in room 4 below the drum for thepurpose of enabling the table 38 to be accommodated below and partiallybeneath the table 34 and to have suflicient space'in which to freelyoperate within the required distance from the centre of X-ray source.The table 38-is supported upon the platform or bench 39 extendingoutwardly from the alcove. The vertical rotative axis 4Q of the table isbisected by the beam 41 from the angularly disposed window 42diametrically opposite the window 25.

It will be seen that by this construction the vertical axes of the fourtables are in a common plane at right angles to the drum axis, and thateach patient can be centred to the proper skin target distance. Y Byreferring particularly to Figure 1, the simplicity with whichiour'extreme cases from the point of view of difficulty of handling isshown. In room I, a patient suffering from a mediastinal tumor, cancerof the lung, or cancer of the aesophagus, is seated in a position ofmaximum comfort, while receiving a treatment posteriorly. The back ofthe seat, which may be made with strong'Celluloid, combined with asimple automatic centering device, provides for accurate centering ofthe beam which is diaphragmed down to the required area; Anteriorly, thepatient can be'treated with the same ease in room 3. Room 2 is shown ascontaining a medullablastoma patient receiving post operative treatmentto the spine. A case of cancer-at the base of the tongue is shown inroom 3, whereas in room 4 a patient is shown undergoing treatment forcancer of the orbit, antrum or nasopharynx.

Inasmuch as skin target distance is a factor of major importance inX-ray therapy, the present invention provides means by which the properdistance can be obtained and maintained by the radiologist and changesmade to suit his individual'technique with a high degree of flexibility.

Adverting to the modification shown in Figure 6, this is substantiallythe same as the treatment room structure already described with theexception that the impervious drum 43 is vertically arranged and thewindows 44 are slightly differently disposed to have similar angles ofincidents with the vertical axes of rotation of the tables (not shown)supported on the benches 45. In this construction the walls 60 compose atreatment room for a patient. A part of the vertical drum 43, containingthe X-ray tube, protrudes into the room and has a portal or window fordownwardly directing an X-ray beam at a suitable angle for treatment. Onthe far side of this room is a. similar room (not shown) into which apart of the drum protrudes and has a similarly disposed window or portalfor a beam. At the left a still further treatment room is provided bythe walls Bl which room has an elevated floor and is let into the roomsaforesaid so that the drum will break into the inner walls thereof andthus allow another window to discharge a beam into this room. At theright hand side of the drum an opposing elevated room is formed by thepartitioning walls 62 for the treatment of a fourth patient. Byelevation of the floors of the left and right rooms, alcoves may beformed in the other two rooms whereby suflicient space is provided toenable tables to be manipulated so as to maintain the skin targetdistance in carrying out the treatment.

In Figure '7 is a typical mounting of an X-ray tube in a drum. Theimpermeable drum is denoted at 44 and has windows as at 45. The drumextends between opposite walls 46 that form a part of the treatmentrooms. Beyond these walls, the insulators 41 of the X-ray tube 48 arearranged as shown. The filament shield is shown at 49 and the leadtarget is denoted at 50. The X-ray tube herein illustrated is of thetype now manufactured in the United States of America for potentials inexcess of 400 kilovolts and is operated under constant evacuation bysuitable pumps. The cathode filament ejects electrons which fall througha potential difference of about 1200 kilovolts and then strike thetarget. Most of the energy is converted into heat at the target, butabout one-half of one per cent of the former is converted into X-rayradiation. The body of the tube in the room-or in the rooms according tothe present invention-where treatments are given, consists of a steeldrum encased in heavy lead which prevents undesired X-rays from strikingthe patients. The openings, denoted at 45, in the lead provide thewindows or portals and may have diaphragms to restrict the radiation toa field of proper size and shape for the part of the body to beirradiated. Speedy vacuum pumps and tight joints are used to secure therequisite reduction of absolute pressure within the tube. Lead gasketsunder heavy presure are employed to prevent leakage. Potential gradientsare reduced by the use of shields at intermediate points. The shieldsand electrodes are supported and housed by glazed porcelain bushings 47.The vacuum pump connection is behind a shield which prevents gaseousdischarges from getting into the evacuation pump.

What I claim is:

l. The combination in an X-ray treatment structure, of an imperviousdrum, a plurality of treatment rooms grouped about the drum and havingdividing walls meeting the annular extent of the drum whereby a portionof the annular surface of the drum is exposed in each room, the

floors of the rooms being disposed at diiferent elevations and inoverlying relation such that they relatively interfit about the drumwithin unobstructed target distance, an X-ray tube extending through thedrum, and windows so arranged in the drum as to angularlyproject a beaminto each room, and a treatment table supported in each room forrotation about a vertical axis coincident with the" skin target distancefor treatthe drum, an X-ray tube housed in the drum,

Windows so arranged in the exposed annular surface of the drum as toproject a beam into each room, at a downward or upward angle, and atreatment table supported in eachroom for rotation about a vertical axisat a skin target distance from the source of radiation.

3. The combination in an X-ray treatment structure, of an impervioushorizontal drum so incorporated in dividing walls of a group ofhorizontal treatment rooms as to compose a part of the wall structurethereof, the rooms being disposed at different elevations and inoverlying relation such as to produce alcoves in certain of the roomswhereby space is provided therein for the treatment of patients within askin target distance of the source of radiation within the drum,treatment tables operably supported in the rooms, means providing amounting for each table and including an element whereby the table isrotatable about a fixed vertical axis located at the skin targetdistance, an X-ray tube in the drum, and windows so angularly arrangedin the drum as to project a beam into each room at an angle to thevertical axis of rotation of each table.

4. In an X-ray treatment structure, a horizontal impervious drum forcontaining an X-ray tube, a horizontal wall leading from the peripheryof the drum substantially at the top thereof and forming a floor of atreatment room thereabove, an upwardly inclined wall meeting theperiphery of the drum at the top thereof and terminating in a verticalpartitioning wall, a window in the top of the drum for angularlyprojecting av beam into the room above mentioned, a subjacent wallhorizontally extending from the drum beneath the aforesaid inclined walland spaced therefrom so as to compose a part of an adjoining treatmentroom, a lateralwindow in the drum for projecting a beam into the room atan upward angle between said subjacent wall and said inclined wall, ahorizontal wall disposed below the drum and offset thereto beneath thefirst mentioned horizontal wall, vertical and horizontal partitioningwalls: joining the offset wall and the bottom of the drum and forming apart of an intermediate room, a lateral window in the drum forprojectinga beam into this room at a downward angle, a horizontal wallbeneath the afore said subjacent wall and forming the floor of a roomtherebelow, and a window in the bottom portion of the drum forprojecting a beam downwardly into the last mentioned room.

5. In an X-ray treatment structure, the combination of a group oftreatment rooms having divisional'walls and having relatively elevatedfloor walls, an impervious drum built into the rooms as a unit with saidwall structure, the arrangement of the drum being such as to have aperipheral portion exposed in each room a window disposed in each of theexposed peripheral portions of the drum, an X-ray tube mountedinteriorly of the drum for discharge of beams through the windows, atable in each room, and a support therefor whereby the table may beadjusted and turned about a vertical axis at a skin target distance fromthe radiation source, the entire aforesaid structure being characterizedin that the wall structure of the rooms is so constructed and arrangedwith respect of the drum that space is provided thereabout whereby theseveral tables are capable of adjustment and rotation about therespective vertical axes of their supports within skin target distanceof the radiation source of the X-ray tube.

6. The combination in an X-ray treatment structure, of an imperviousdrum, a plurality of treatment rooms grouped about the drum and havingthe drum incorporated as part of the wall structure thereof such as toexpose a part of the annular surface in each room, the rooms beingconstructed in superimposed and overlying relation such as to producealcoves in certain of the rooms. adjoining the drum whereby space isprovided for the treatment of patients within skin target distance ofthe drum, an X-ray tube housed in the drum, windows so arranged in theexposed annular surface of the drum as to angularly project a beam intoeach room, and a treatment table supported in each room for turningmovement about a fixed vertical axis at a skin target distance from thesource of radiation.

'7. The combination in an X-ray treatment structure of an imperviousdrum, four treatment rooms grouped about the drum and having dividingwalls-meeting the annular extent of the drum whereby a portion of theannular surface of the drum is exposed in each room, the rooms beingdisposed at difierent elevations and in overlying relation such as toproduce alcoves in certain of the rooms whereby space is providedtherein 'for the treatment of patients within skin target distanoe ofthe drum, an X-ray tube housed in the drum, windows so arranged in theexposed annular surface of the drum as to project a beam into each room,at a downward or upward angle, and a treatment table supported in eachroom for rotation about a vertical axis at a skin target distance fromthe sourcelof radiation.

ARTHUR F. JEANS.

